2004, 05-12 Permit App: BLD-04-04338 PoolSam
„,,Valley
PERMIT APPLICATION WORK SHEET
SPOKANE VALLEY COMMUNITY DEVELOPMENT
BUILDING DIVISION
11707 East Sprague Ave Ste 106
Spokane Valley, WA 99206
Phone: (509)688-0036 Fax: (509)688-0037
REQUIRED SITE INFORMATION
STREET ADDRESS: cV3 Z5 € O TijA n
ASSESSOR'S TAX PARCEL NUMBER(S):
LEGAL DISCRIPTION:
PERMIT DESCRIPTION: I rv7ro X �,�-C
BUII DING PERMITCHA GE IN USE•
[ 1
RELOCATION ® SIGN
GRADING 0 MANUFACTURED HOME
TENANT O OTHER
1
OWNER / APPLICANT INFORMATION
-if
IR OWNER: 1/01• NO4A-MaTn5 VIIN APPLICANT: [ "VL a'S COM-fcader
PHONE: C\2R 12,6 FAX: PHONE: FAX:
iii -k7_, E W CVS;16-", ADDRESS: o. CU \ rAZ� nDRESS-
CITY,STATE, Z P '.
-.\ 1 , CITY, STATE, ZIP
V
< CONTRACTOR: \�\SV� ^ I VS WC EI ARCHITECT:
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PHONE: LkU1- 0104 �F�AI�X^\`1f 1-03gZ ��p, PHONE:
ADDRESS: �5 . �1_\.WI N41 & \fa Cn2�c ADDRESS:
CITY, STATE, ZIP
WA ST CONTRACTOR LICENSE # "PANZL' LOQ -IDS CONTACT:
FAX:
CITY, STATE, ZIP
PERMIT/BUILDING INFORMATION
COST OF PROJECT:
30% SLOPES ON PROPERTY: MAIN FLOOR SQ FT:
BUILDING HEIGHT TO PEAK: OCCUPANCY GROUP: 2N9 FLOOR SQ FT:
BUILDING DIMENSIONS: CONSTRUCTION TYPE: UNFIN BASEMENT:
NUMBER OF STORIES: STRUCTURES ON PROPERTY: FINISHED BASEMENT:
NUMBER of BEDROOMS: CRITICAL AREAS: GARAGE:
DATE:
1
STAFF:
METHOD OF PAYMENT:
CASH CHECK
BANKCARD #,• EXPIRES: VIN #
AUTHORIZED SIGNATURE*
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WSA
05/11/2004 13:24 5093241567 SRHD EHS
THE LOCATION OF
SYSTEM REPRESFN
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rnpion is being submitted for the punters o1
obtai a building pp and is a Ines f
,e septation of the proposal. AN know
Ines: dimensions. curb lines. str,dwasand
ave been identified. Mao indiCalled ars
bGemareas.
undies � �' sL.
Signed:
Date'
ADDRESS 911, 5 g --
ZONE ZONE O
ROAD WIDTH
FRONT tai`) t UNIT
COMMENTS
REVIEWED
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